Long-segment patchplasty of diffuse left anterior descending artery disease on the beating heart

Abstract

Objective:The rate of patients with diffuse left anterior descending artery (LAD) disease being referred for surgery has increased as a result of advances in endovascular techniques. In surgery of diffuse or multisegment LAD disease, surgical procedures with or without endarterectomy can be performed. In this article, we report our results of longsegment onlay patchplasty of the LAD with a left internal thoracic artery (LITA) graft without endarterectomy, on the beating heart, in patients with multisegment LAD disease. Methods: We retrospectively analysed patients who underwent coronary artery bypass grafting surgery in our hospital between 1 January 2015 and 31 July 2017. We included LITA onlay patchplasty patients with multisegment LAD disease who had been operated on the beating heart. We excluded patients who underwent coronary endarterectomy and were operated on under cardiopulmonary bypass. Results: In this period, 54 patients with multisegment LAD disease were treated with LITA patchplasty on the beating heart. The mean length of the arteriotomy was 42.8 ± 13.3 mm (25-75 mm). There were two postoperative myocardial infarctions (3.7%) and three deaths (5.5%). In the remaining patients, there was no haemodynamic instability that needed long-term (> 24 hour) inotropic support. Patients were discharged from hospital on postoperative 9.3 ± 7.1 days with dual antiplatalet therapy. Conclusion: Bypass grafting of the LAD with long-segment LITA onlay patchplasty can safely be performed in patients with multisegment LAD disease, with acceptable early-term results. In this procedure, proximal and distal segments of the diseased LAD are revascularised with LITA grafts, which may improve long-term survival and quality of life.

Early Outcomes of Using Skeletonized Left Internal Mammary Artery (LIMA) for Sequential Grafting of Multiple Left Anterior Descending Artery Lesions

“…Moreover, plaque fracture may lead to imminent dissection in the anastomosis area and further occlusion [31] . Also, Kaya et al [32] found that in the second method diffuse lesions are managed by using small arteriotomies in seemingly normal LAD artery areas or anterolateral wall with fewer plaque densities and then side to side LIMA anastomosis and multi-segment jump anastomosis are performed. Additionally, a multicentre propensity-matched research of sequential vein grafting of the heart performed by Skov et al [33] found that jump grafts were related with decreased postoperative haemorrhage durations as well as shorter bypass (as our study) and Cross clamp time.…”